| NPI | 1093236630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: FL OTA17469) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: GA OTA001923) |
| 224Z00000X Occupational Therapy Assistant (Licence: TX 213486) | |
| Enumeration Date | 2017-07-05 |
| Last Update Date | 2020-05-21 |